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Ask Dr. K: Perforated eardrums heal on their own

The eardrum is delicate – and it has to be. Sound waves that enter your ear move the eardrum, which begins the process that allows you to hear. If it weren’t thin and delicate, the eardrum wouldn’t vibrate so sensitively when sound waves hit it. But because it is thin and delicate, it can be torn (perforated) easily. As in your case, it is most often torn by an ear infection. But other types of trauma, including a very loud noise, or even a cotton swab inserted into the ear during cleaning, can also damage it. If the tear is small, your doctor may allow it to heal on its own. Most perforated eardrums heal in a few weeks to two months.

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Articles of Interest

EM@3AM: Tympanic Membrane Rupture

Simple, small, isolated perforation: heals in 4-6 weeks, provide antibiotic ear drops for contaminated wounds (external puncture, perforation with water contamination, canal occluded with blood or drainage in those with middle ear trauma) with ciprofloxacin or ofloxacin, keep water out of ear, avoid Valsalva. Follow up with primary care provider. If associated with otitis media in pediatric patients, administer PO antibiotics.

Perforated eardrum and eardrum repair

If a perforation develops, we generally advise keeping the ear as dry as possible, and the healing process may be improved by using gentle antibiotic drops such as ciprofloxacin, particularly if the ear has been infected. Generally, the hole will heal up within 2 to 3 weeks, so it is particularly important to keep the ear dry during this period and to avoid pressure changes: swimming and flying should be avoided for about six weeks afterwards, to make sure that everything has healed. If the perforation has been present for quite a long time, it is more likely that the edges of this will scar over, meaning that the skin can’t grow back across the hole to seal it. In these cases, it is unlikely…

Marching to a new beat

In the most severe cases, a ruptured eardrum can require surgery to put it right, but tissue-engineering techniques might provide a much simpler solution.

Do I Have a Ruptured Eardrum? Here’s How to Tell

“We usually recommend placing a cotton ball covered in Vaseline in the ear when showering and avoiding putting your head under water,” Adams said. With proper care, a small, punctured eardrum may recover in a few weeks or few months. If it doesn’t heal, there are a few surgical techniques such as tympanoplasty or paper patch myringoplasty. These can help either patch the hole or rebuild a new eardrum depending on how big the perforation is.

Ear Blast Injuries

Any TM perforation runs the risk of cholesteatoma formation, especially those perforations that are larger and do not resolve; follow-up is indicated biannually for a minimum of two years.

Perforated Tympanic Membrane (Ruptured Eardrum)

With a true TM perforation, place a protective cotton plug inside the ear canal, and instruct the patient to keep the canal dry by using soft wax earplugs while showering. He should also avoid submerging his head under water until the perforation is completely healed. Prescribe the ototopical antibiotic ofloxacin (Floxin Otic) 5 mL, 3 to 5 drops in ear bid × 3 to 5 days, only if the lacerated TM and middle ear were contaminated with lake water, seawater, or a dirty object, such as a tree branch.

Ruptured Eardrum: Help, I’ve got a Hole in my Eardrum!

Forcing your eardrums to “pop” by blowing your nose with the nose pinched shut, may generate extremely high nasal pressures which, if transmitted via the Eustachian pressure tubes connecting to your ears, may lead to a sudden high pressure wave to injure and perforate your eardrum.

Ruptured Eardrums: Summer Hazards & The Road To Recovery

Ruptured eardrums often cause sharp or intense pain in the affected ear. The pain may subside once the eardrum has ruptured, but it can continue or worsen if an infection develops.

Resources

StatPearls

Treatment is primarily supportive, as TM perforations generally heal spontaneously. The ear should be kept dry as much as possible since it can predispose to infection if the ear is wet. One prospective study of traumatic perforation demonstrated that the use of ofloxacin otic drops improved rate and time to closure of the perforation compared to those not treated. However, it was also found that ofloxacin drops made no change in hearing outcomes or the rate of AOM secondary to large perforations. Routine antibiotic treatment is often unnecessary.